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GH-axis

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GHRH analog

Tesamorelin

Also known as: Egrifta, TH9507, Egrifta SV

FDA-approved for HIV-associated lipodystrophy. Off-label use for general fat loss is meaningfully less supported.

Reviewed 2026-04-30

What it does

Tesamorelin is a 44-amino-acid synthetic analog of human growth hormone-releasing hormone (GHRH). It stimulates pulsatile endogenous GH release from the pituitary, raising IGF-1. Phase 3 trials in HIV-associated lipodystrophy demonstrated reductions in visceral adipose tissue (VAT) of roughly 15–18% and supported the FDA approval of Egrifta in 2010 for that specific indication. Off-label use for non-HIV abdominal adiposity, longevity, or body composition has substantially weaker evidence.

Used for

Dose

Dose
2,000 mcg · once daily
When
BedtimeFDA-approved at bedtime in the HIV-lipodystrophy indication for exactly the same reason as the rest of the GHRH axis: GH-pulse alignment during slow-wave sleep.
How long
6 months on / 2 months off
Site
subcutaneous
Food
fasted

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⚠ Caution

  • Active malignancy (relative; raised IGF-1 is theoretically permissive of tumor growth)
  • Pituitary surgery, radiation, or trauma — confirm pituitary axis with provider first
  • Pregnancy and breastfeeding
  • Hypersensitivity to mannitol or other excipients
  • Severe respiratory failure or critical illness
  • Acute glucose dysregulation; tesamorelin can transiently elevate fasting glucose

Medications & conditions

  • Dual GHRH analog stacking — amplified GH/IGF-1 axis activationStacking tesamorelin with another GHRH analog or growth-hormone secretagogue creates redundant mechanism overlap. The combination amplifies endogenous GH release and IGF-1 elevation, increasing the risk of insulin resistance, joint pain, fluid retention, and (theoretically) accelerated growth of any subclinical neoplasm. Use one GH-axis peptide at a time.
  • Tesamorelin contraindicated in active oncologyTesamorelin is explicitly contraindicated in patients with active malignancy per the FDA label. GH/IGF-1 axis activation can support tumor growth and is not appropriate during cancer treatment. Discontinue and discuss with the oncology team.
  • Tesamorelin with corticosteroid — blunted GH responseUser is taking a corticosteroid. Chronic high-dose glucocorticoid use suppresses the hypothalamic-pituitary axis and meaningfully blunts the GH-releasing effect of tesamorelin. Concurrent use reduces the VAT-reduction benefit documented in Phase 3 trials.

Will it work for me?

Establish a baseline (2–3 readings over 1–2 weeks before starting), then track at consistent intervals.

Blood markers
  • Tier 1 — Human RCTIGF-1· by 8 weeks; stay within age-adjusted range — do not chase supraphysiologic
  • Tier 1 — Human RCTTriglycerides· 12–26 weeks
  • Tier 1 — Human RCTALT / AST (MASLD context)· 12–26 weeksOnly relevant when used in a fatty-liver context with elevated baseline enzymes.
Imaging
  • Tier 2 — Human observationalVisceral adipose tissue (VAT) via DEXA· DEXA at 12 and 26 weeksPrimary FDA-trial endpoint — ~15–20% VAT reduction at 26 weeks.
Functional & psychometric
  • Tier 3 — Animal / in vitroWaist circumference· 12–26 weeksTape-measure proxy for VAT; track alongside DEXA.

Often stacked with

  • IpamorelinTesamorelin (GHRH analog, FDA-approved) amplifies the GHRH axis; Ipamorelin adds a selective ghrelin-pathway GH pulse — the same GHRH + GHRP dual-pathway synergy as CJC/Ipamorelin, applied with a more clinically characterised GHRH analog.

Your stack

Track this peptide in your protocol — dose, schedule, vials on hand, refill projection. Stays in your browser; no account needed.

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Use this peptide

Cycling

6 months on, 2 months off.

Sex-specific dosing
Female
1 mg (10 units) SQ daily
Male
2 mg (20 units) SQ daily — the FDA-approved Egrifta dose

Women have a higher endogenous GH/IGF-1 response to GHRH at lower doses; the lower female dose maintains efficacy while reducing fluid retention and joint side effects.

Related peptides

Part of these blends

Co-injection & overlap

Can share a syringe with: Ipamorelin

Reconstitution & storage
VialBAC waterConcentrationShelf life
10 mg1 mL1 mg per 10 units2 weeks
20 mg2 mL1 mg per 10 units2 weeks
40 mg4 mL1 mg per 10 units1 month

Branded Egrifta SV uses supplied sterile water and must be used within 2 hours of reconstitution — it has no preservative. The table below applies to compounded multi-mg vials reconstituted with bacteriostatic water; swirl gently, do not shake.

Storage. Lyophilized vial: refrigerate 2–8 °C until reconstitution. Reconstituted product: use immediately. Do not freeze. Protect from light.

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Nasal delivery

Not suitable for nasal delivery. SQ only — protein structure and the need for systemic delivery to the pituitary make nasal absorption non-viable.

Monitoring & questions

Reported side effects
  • Injection site reactions (most common; redness, itching, induration)
  • Arthralgia and peripheral edema
  • Hyperglycemia and worsened insulin resistance (monitor HbA1c, fasting glucose)
  • Carpal tunnel-like symptoms with high IGF-1 elevations
  • Headache, fatigue
  • Hypersensitivity reactions (rare)
Biomarkers Juno tracks
FAQ (2)

Reference

How it works

Binds the pituitary GHRH receptor, triggering endogenous pulsatile GH release. Because the GH increase is endogenous and pulsatile, the metabolic profile differs from exogenous recombinant GH — typically less impact on glucose and IGF-1 ceilings.

EvidenceTier 1 — Human RCT

Tiers are per indication. The same molecule can be Tier 1 for one use and Tier 4 for another — the tier reflects published literature, not community framing.

HIV-associated lipodystrophy (visceral adiposity)

Tier 1high confidence

Falutz et al. and subsequent Phase 3 trials demonstrated 15–18% reduction in visceral adipose tissue at 26 weeks. FDA approved as Egrifta in 2010.

Non-HIV abdominal adiposity

Tier 2medium confidence

Several smaller trials in non-HIV populations report reductions in VAT and triglycerides, but the bulk of the evidence is in HIV subjects. Tier 1 evidence does not propagate from the approved indication.

NAFLD / hepatic steatosis

Tier 2medium confidence

Stanley et al. demonstrated reductions in hepatic fat fraction in HIV patients with NAFLD. Evidence in non-HIV NAFLD is more limited.

General longevity / anti-aging

Tier 3high confidence

No human RCTs assess longevity endpoints with tesamorelin. Mechanistic claims that raising GH/IGF-1 extends healthspan rest on indirect inference, and observational data on IGF-1 and longevity are mixed (with higher IGF-1 sometimes associated with worse cancer outcomes).

No primary citations are anchored to this indication — the tier reflects the absence of usable literature, not a missing reference.

Cognitive performance

Tier 2medium confidence

A small RCT (Baker et al.) reported cognitive improvements in adults with mild cognitive impairment receiving tesamorelin. Results are interesting but unreplicated at scale.

Citations (4)
  1. [1]
    Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, in HIV-infected patients with excess abdominal fat
    Falutz J, Allas S, Blot K, et al. · New England Journal of Medicine · 2007 · PMID 18046018
    Tier 1 evidence for HIV lipodystrophy and the basis for FDA approval.
    View source
  2. [2]
    Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation
    Stanley TL, Feldpausch MN, Oh J, et al. · JAMA · 2014 · PMID 25069834
    Hepatic fat reduction in HIV patients; supports the NAFLD-adjacent claim.
    View source
  3. [3]
    Effects of growth hormone-releasing hormone on cognitive function in adults with mild cognitive impairment and healthy older adults
    Baker LD, Barsness SM, Borson S, et al. · Archives of Neurology · 2012 · PMID 22689070
    Small-RCT support for the cognition indication.
    View source
  4. [4]
    Egrifta SV (tesamorelin) Prescribing Information
    Theratechnologies Inc. · FDA-approved label · 2019
    Approved indication, dose, and contraindications.
    View source